Paris MEM: a study protocol for an effectiveness and efficiency trial on the treatment of traumatic stress in France after the 2015-16 terrorist attacks

BACKGROUND

The Paris and Nice terrorist attacks affected a thousand of trauma victims and first-line responders. Because there were concerns that this might represent the first of several attacks, there was a need to quickly enhance the local capacities to treat a large number of individuals suffering from trauma-related disorders. Since Reconsolidation Therapy (RT) is brief, relatively easy to learn, well tolerated and effective, it appeared as the ideal first-line treatment to teach to clinicians in this context.

METHODS

This study protocol is a two-arm non-randomized, multicenter controlled trial, comparing RT to treatment as usual for the treatment of trauma-related disorders. RT consists of actively recalling one's traumatic event under the influence of the ß-blocker propranolol, once a week, for 10-25 min with a therapist, over 6 consecutive weeks. This protocol evaluates the feasibility, effectiveness, and cost-utility of implementing RT as part of a large multi-center (N = 400) pragmatic trial with a one-year follow-up.

DISCUSSION

Paris MEM is the largest trial to date assessing the efficiency of RT in the aftermath of a large-scale man-made disaster. RT could possibly reinforce the therapeutic arsenal for the treatment of patients suffering from trauma-related disorders, not only for communities in western countries but also worldwide for terror- or disaster-stricken communities.

TRIAL REGISTRATION

Clinical Trials (ClinicalTrials.gov). June 3, 2016. NCT02789982.

Feather pecking in laying hens housed in free-range or furnished-cage systems on French farms

1. Beak trimming is currently used in France to avoid the negative consequences of severe feather pecking (SFP). However, this practice is controversial in terms of animal welfare, and forbidden in some European countries.2. This study aimed to assess the prevalence of SFP in French laying hen farms, to describe how farmers manage this behavioural disorder and to better understand the risk factors involved.3. A study was carried out from April 2015 to June 2016. Visits were paid to 79 flocks kept in furnished cages (FC) and 80 flocks in a free-range (FR) system. All the hens had trimmed beaks and were genotypically brown. The information collected included feather cover, skin damage, beak condition, farm and poultry house characteristics, livestock performance and management.4. The prevalence of SFP in FC flocks was estimated at 32.9% (IC = 95%, [22.5; 43.3]) and the prevalence of cannibalism as 2.5% (IC = 95%, [0.7; 8.8]) at 70 weeks of age. The prevalence of SFP in FR flocks was estimated to be 23.8% (IC = 95%, [14.5; 31.1]) and the prevalence of cannibalism was 8.8% (IC = 95%, [4.3; 17.0]) at 61 weeks of age.5. In FC flocks, SFP was associated with the combination of genotype, type and length of perches, cage area per hen, type of lighting, number of hens per cage and farm location. In FR flocks, feather cover was associated with use of the outdoor run, lighting programme, genotype, farm location and date of house construction.

Perspectives on the amorphisation/milling relationship in pharmaceutical materials

This paper presents an overview of recent advances in understanding the role of the amorphous state in the physical and chemical transformations of pharmaceutical materials induced by mechanical milling. The following points are addressed: (1) Is milling really able to amorphise crystals?, (2) Conditions for obtaining an amorphisation, (3) Milling of hydrates, (4) Producing amorphous state without changing the chemical nature, (5) Milling induced crystal to crystal transformations: mediation by an amorphous state, (6) Nature of the amorphous state obtained by milling, (7) Milling of amorphous compounds: accelerated aging or rejuvenation, (8) Specific recrystallisation behaviour, and (9) Toward a rationalisation and conceptual framework.

Dynamic nuclear polarization of a glassy matrix prepared by solid state mechanochemical amorphization of crystalline substances

A mechanochemical "solvent-free" route is presented for the preparation of solid samples ready to be employed in the Dynamic Nuclear Polarization (DNP). (1)H-DNP build-up curves at 3.46 T as a function of temperature and radical concentration show steady state nuclear polarization of 10% (0.5% TEMPO concentration at 1.75 K).

Solid state amorphization of pharmaceuticals

Amorphous solids are conventionally formed by supercooling liquids or by concentrating noncrystallizing solutes (spray-drying and freeze-drying). However, a lot of pharmaceutical processes may also directly convert compounds from crystal to noncrystal which may have desired or undesired consequences for their stability. The purpose of this short review paper is (i) to illustrate the possibility to amorphize one compound by several different routes (supercooling, dehydration of hydrate, milling, annealing of metastable crystalline forms), (ii) to examine factors that favor crystal to glass rather than crystal to crystal transformations, (iii) to discuss the role of possible amorphous intermediates in solid-solid conversions induced by milling, (iv) to address the issue of chemical stability in the course of solid state amorphization, (v) to discuss the nature of the amorphous state obtained by the nonconventional routes, (vi) to show the effect of milling conditions on glasses properties, and (vii) to attempt to rationalize the observed transformations using the concepts of effective temperature introduced in nonequilibrium physics.

Biological and physico-chemical assessment of hydroxyapatite (HA) with different porosity

HA with specific internal porosities was loaded with different antibiotics (ATBs) and then tested on its microbiological effectiveness. The HA purity was controlled with X-ray diffraction, IR and Raman spectrometry. Varying the sintering temperature and/or adding graphite and PMMA as porogenous agents lead to obtained micro- and meso-porosities. The biological tests concerned cell viability, proliferation and morphology (SEM), and the cytochemical staining of actin and vinculin. The micro- and meso-porous HA samples had an internal pore size of 1-10 microm and 10-50 microm, respectively. X-ray diffraction and FTIR confirmed the high purity of the HA. The cell viability tests with L132 cells confirmed the excellent cytocompatibility of HA, the graphite powder and the ATB vancomycine. Proliferation rate was assessed with MC3T3-E1 osteoblasts. All HA samples produced a higher proliferation than the controls; the micro-porous HA inducing the highest cell growth. The ATB impregnated HA also stimulated cell proliferation but in lower extend. Cytochemical staining of osteoblasts revealed a well-developed cytoskeleton with strong stress fibres. Labelling of the focal adhesion contacts with anti-vinculin showed a less developed adhesion process in the cells on the different HA substrates. It was possible to realize a highly pure hydroxyapatite with different but controlled porosities by varying the sintering temperature and/or addition of a porogenous agents. This purity and the micro-porosity stimulate significantly cell growth.

Antibacterial activation of hydroxyapatite (HA) with controlled porosity by different antibiotics

In order to prevent the increasing frequency of per-operative infections, bioceramics can be loaded with anti-bacterial agents, which will release with respect to their chemical characteristics. A novel hydroxyapatite (HA) was elaborated with specific internal porosities for using as a bone-bioactive antibiotic (ATB) carrier material. UV spectrophotometry and bacteria inhibition tests were performed for testing the ATB adsorption and the microbiological effectiveness after loading with different antibiotics. The impregnation time, ATB impregnating concentration, impregnation condition and other factors, which might influence the ATB loading effect, were studied by exposure to different releasing solvents and different pathogenic bacteria: Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli. It clearly showed that the facility of ATB loading on this porous HA is even possible just under simple non-vacuum impregnation conditions in a not-so-long impregnating interval. The results also showed that, for all three types of ATB (vancomycin, ciprofloxacin and gentamicin), adsorbed amount on the micro-porous HA were hugely higher than that on dense HA. The micro-porosity of test HA had also significantly prolonged the release time of antibiotics even under mimic physiological conditions. Furthermore, it also has primarily proved by a pilot test that the antibacterial efficiency of crude micro-porous HA could be further significantly improved by other methods of functionalization such as cold plasma technique.

Evidence of a two-stage thermal denaturation process in lysozyme: a Raman scattering and differential scanning calorimetry investigation

Raman spectroscopy (in the low-frequency range and the amide I band region) and modulated differential scanning calorimetry investigations have been used to analyze temperature-induced structural changes in lysozyme dissolved in 1H2O and 2H2O in the thermal denaturation process. Low-frequency Raman data reveal a change in tertiary structure without concomitant unfolding of the secondary structure. Calorimetric data show that this structural change is responsible for the configurational entropy change associated with the strong-to-fragile liquid transition and correspond to about 1/3 of the native-denaturated transition enthalpy. This is the first stage of the thermal denaturation which is a precursor of the secondary structure change and is determined to be strongly dependent on the stability of the hydrogen-bond network in water. Low-frequency Raman spectroscopy provides information on the flexibility of the tertiary structure (in the native state and the transient folding state) in relation to the fragility of the mixture. The unfolding of the secondary structure appears as a consequence of the change in the tertiary structure and independent of the solvent. Protein conformational stability is directly dependent on the stability of the native tertiary structure. The structural transformation of tertiary structure can be detected through the enhanced 1H/2H exchange inhibited in native proteins. Taking into account similar features reported in the literature observed for different proteins it can be considered that the two-stage transformation observed in lysozyme dissolved in water is a general mechanism for the thermal denaturation of proteins.

How Do Trehalose, Maltose, and Sucrose Influence Some Structural and Dynamical Properties of Lysozyme? Insight from Molecular Dynamics Simulations

The influence of three well-known disaccharides, namely, trehalose, maltose, and sucrose, on some structural and dynamical properties of lysozyme has been investigated by means of molecular dynamics computer simulations in the 37-60 wt % concentration range. The effects of sugars on the protein conformation are found to be relatively weak, in agreement with the preferential hydration of lysozyme. Conversely, sugars seem to increase significantly the relaxation times of the protein. These effects are shown to be correlated to the fractional solvent accessibilities of lysozyme residues and further support the slaving of protein dynamics. Moreover, a significant increase in the relaxation times of lysozyme, sugars, and water molecules is observed within the studied concentration range and may result from the percolation of the hydrogen-bond network of sugar molecules. This percolation appears to be of primary importance to explain the influence of sugars on the dynamical properties of lysozyme and water.

How homogeneous are the trehalose, maltose, and sucrose water solutions? An insight from molecular dynamics simulations

The structural properties resulting from the reciprocal influence between water and three well-known homologous disaccharides, namely, trehalose, maltose, and sucrose, in aqueous solutions have been investigated in the 4-66 wt % concentration range by means of molecular dynamics computer simulations. Hydration numbers clearly show that trehalose binds to a larger number of water molecules than do maltose or sucrose, thus affecting the water structure to a deeper extent. Two-dimensional radial distribution functions of trehalose solutions definitely reveal that water is preferentially localized at the hydration sites found in the trehalose dihydrate crystal, this tendency being enhanced when increasing trehalose concentration. Over a rather wide concentration range (4-49 wt %), the fluctuations of the radius of gyration and of the glycosidic dihedral angles of trehalose indicate a higher flexibility with respect to maltose and sucrose. At sugar concentrations between 33 and 66 wt %, the mean sugar cluster size and the number of sugar-sugar hydrogen bonds formed within sugar clusters reveal that trehalose is able to form larger clusters than sucrose but smaller than maltose. These features suggest that trehalose-water mixtures would be more homogeneous than the two others, thus reducing both desiccation stresses and ice formation.

Transformation of pharmaceutical compounds upon milling and comilling: the role of T(g)

Milling is a usual process used in the course of drug formulation, which however may change the physical nature of the end product. The diversity of the transformations of organic compounds upon milling has been widely demonstrated in the pharmaceutical literature. However, no effort has still been devoted to study the correlation between the nature of the transformation and the milling conditions. Results clarifying such transformations are shortly reviewed with special attention paid to the temperature of milling. The importance of the position of the glass transition temperature compared with that of milling is demonstrated. It is shown that decreasing the milling temperature leads to an increase of the amorphization tendency whereas milling above T(g) can produce a crystal-to-crystal transformation between polymorphic varieties. These observations contradict the usual suggestion that milling transforms the physical state only by a heating effect which induces a local melting. Equilibrium thermodynamics does not seem appropriate for describing the process. The driven alloys concept offers a more rational framework to interpret the effect of the milling temperature. Other results are also presented, which demonstrate the possibility for milling to form low temperature solid-state alloys that offer new promising ways to stabilize amorphous molecular solids.

Analysis of sugar bioprotective mechanisms on the thermal denaturation of lysozyme from Raman scattering and differential scanning calorimetry investigations

Sugar-induced thermostabilization of lysozyme was analyzed by Raman scattering and modulated differential scanning calorimetry investigations, for three disaccharides (maltose, sucrose, and trehalose) characterized by the same chemical formula (C(12)H(22)O(11)). This study shows that trehalose is the most effective in stabilizing the folded secondary structure of the protein. The influence of sugars on the mechanism of thermal denaturation was carefully investigated by Raman scattering experiments carried out both in the low-frequency range and in the amide I band region. It was determined that the thermal stability of the hydrogen-bond network of water, highly dependent on the presence of sugars, contributes to the stabilization of the native tertiary structure and inhibits the first stage of denaturation, that is, the transformation of the tertiary structure into a highly flexible state with intact secondary structure. It was found that trehalose exhibits exceptional capabilities to distort the tetra-bonded hydrogen-bond network of water and to strengthen intermolecular O-H interactions responsible for the stability of the tertiary structure. Trehalose was also observed to be the best stabilizer of the folded secondary structure, in the transient tertiary structure, leading to a high-temperature shift of the unfolding process (the second stage of denaturation). This was interpreted from the consideration that the transient tertiary structure is less flexible and inhibits the solvent accessibility around the hydrophobic groups of lysozyme.

Metastability Release of the Form α of Trehalose by Isothermal Solid State Vitrification

Kinetic investigations of the polymorphic form alpha of anhydrous trehalose have been performed below its apparent melting temperature (Tm) by differential scanning calorimetry (DSC) and X-ray diffraction. The results reveal a spontaneous isothermal vitrification process which indicates that the phase alpha is in a very unusual superheating situation. This behavior has been attributed to the fact that the effective melting temperature (Tm(eff)) of the phase alpha is likely to be located far below the glass transition temperature (Tg) of this compound. The high viscosity of the liquid trehalose between Tm(eff) and Tg is thus invoked to explain the long lifetime of the phase alpha in this temperature range.

Molecular Mobility in Glass Forming Fananserine: A Dielectric, NMR, and TMDSC Investigation

PURPOSE

This study was conducted to characterize the molecular mobility of supercooled fananserine and derive from this analysis the non-Arrhenius and nonexponential properties of the primary alpha-relaxation.

METHODS

The use of three investigation techniques of the molecular mobility, namely, dielectric relaxation, modulated differential scanning calorimetry, and proton nuclear magnetic resonance, allowed us to describe the dynamic properties of supercooled fananserine on a wide range of frequencies and temperatures, ranging from the melting temperature T(m) = 372 K down to the glass transition temperature T(g) = 292 K.

RESULTS

We emphasized the capacity of these three techniques to give a coherent set of information. We used the coupling-model theory to interpret the dielectric results. It allowed us to identify two relaxation processes (alpha and beta), corresponding to different molecular motions. The temperature evolution of the alpha-relaxation indicates that fananserine is a fragile glass former, as reflected by the steepness index value, m = 77. The temperature T(o) where the relaxation times diverge was also determined.

CONCLUSIONS

The description of the dielectric relaxation data in terms of the Kohlrausch-Williams-Watt relaxation function has shown the existence of an additional low-amplitude relaxation process assigned to the so-called Johari-Goldstein process. Mainly concerned by the primary alpha-process directly involved in the glass formation, we derived from this analysis the characteristic features of this process and showed that supercooled fananserine is characterized by a strongly non-Arrhenius and nonexponential behavior.

Dynamics of the Amorphous and Crystalline α-, γ-Phases of Indomethacin

Crystallization processes in indomethacin can be observed below Tg leading to different forms depending on the thermal treatment: a rapid and deep quench below Tg leads to the metastable alpha-phase and a slow cooling close to Tg gives rise to the stable gamma-phase. To understand this atypical behavior, we have studied the molecular mobility of the amorphous and crystalline forms of indomethacin by dielectric relaxation and 1H NMR spectroscopy. Two relaxations were detected in the glassy state obtained from the deeply quenched liquid. One, also present in the gamma-phase, was attributed to local rotations. The other one, of very low amplitude, was attributed to the Johari-Goldstein relaxation. The results allowed to discuss the relationship between these two relaxation processes and the crystallization properties of amorphous indomethacin.

Onset of slow dynamics in difluorotetrachloroethane glassy crystal

Complementary neutron spin-echo and x-ray experiments and molecular-dynamics simulations have been performed on difluorotetrachloroethane (CFCl2-CFCl2) glassy crystal. Static, single-molecule reorientational dynamics and collective dynamics properties are investigated. Our results confirm the strong analogy between molecular liquids and plastic crystals. The orientational disorder is characterized at different temperatures and a change in the nature of rotational dynamics is observed. A careful check of the rotational diffusion model is performed using self-angular correlation functions Cl with high l values and compared to results obtained on molecular liquids composed of A-B dumbbells. Below the crossover temperature at which slow dynamics emerge, we show that some scaling predictions of the mode coupling theory hold and that alpha-relaxation times and nonergodicity parameters are controlled by the nontrivial static correlations.

Analogy of the slow dynamics between the supercooled liquid and supercooled plastic crystal states of difluorotetrachloroethane

Slow dynamics of difluorotetrachloroethane in both supercooled plastic crystal and supercooled liquid states have been investigated with molecular dynamics simulations. The temperature and wave-vector dependence of collective dynamics in both states are probed using coherent dynamical scattering functions S (Q,t). Our results confirm the strong analogy between molecular liquids and plastic crystals for which alpha-relaxation times and nonergodicity parameters are controlled by the nontrivial static correlations S (Q), as predicted by the mode coupling theory.

Composition of bone and apatitic biomaterials as revealed by intravital Raman microspectroscopy

Microcharacterization of biominerals allows a better understanding of the pathophysiological events that occur in calcified tissues and synthetic biomaterials. Different methods have been extensively used to conduct such investigations. A new model for the intravital study of the composition and structure of membranous bone by Raman microspectroscopy is described. Titanium bone chambers equipped with a fused-silica optical window were implanted transcutaneously in the calvaria of New Zealand rabbits. The implanted optical windows were well tolerated, and spectral acquisitions were performed without any additional invasive procedure. Bone and implanted apatitic biomaterials were analyzed at different times after surgery. All Raman bands were unambiguously identified in the bone and biomaterial spectra. The main PO4 and CO3 Raman bands in bone spectra were consistent with those found in the carbonated apatite spectrum. The major collagen bands were always observed around 1200-1300 (amide III) and 1600-1700 (amide I) delta cm(-1) and, 1400-1470 and 2800-3100 delta cm(-1) (bending and stretching modes of CH groups, respectively). The phenylalanine (Phe) band was identified in all spectra at 1003 delta cm(-1) and overlapped that of the weak HPO4(2-) ion. The CH bands frequently overlapped the lipid bands. However a distinct protein and lipid bands were detected at 2950 and 2852 delta cm(-1), respectively. In bone areas close to blood vessels, the Raman signature of hemoglobin was detected with a characteristic band at 754 delta cm(-1). The changes observed in bone varied as a function of time and location. The composition and structure of all of the biomaterials studied--including those that were resorbable--seemed to remain stable over time and location. We report for the first time the complete intravital study of Raman spectra of bone and calcium phosphate biomaterials over a period of 8 months. This new approach does not require specimen preparation and allows simultaneous observation of mineral and organic bone constituents over time, which therefore should provide insightful information about their relationship.

Nuclear magnetic resonance and dielectric investigations of molecular motions in a glassy crystal: The mixed compound (CN-adm)0.75(Cl-adm)0.25

The dynamic properties of plastic crystalline mixed adamantane's derivatives namely cyanoadamantane (75%) and chloroadamantane (25%) were investigated by dielectric and nuclear magnetic resonance (NMR) spectroscopy, covering a spectral range of 12 decades in the temperature range 110-420 K. Phase transformations were studied and dynamical parameters of the plastic (I), glassy (Ig), and ordered (III) phases were determined and compared with those of pure compounds. The dynamics of the supercooled plastic phase is characterized by an alpha-process exhibiting an Arrhenius behavior which classified the mixed compound as a strong glass former. In the plastic phase, NMR relaxation times were interpreted by using a Frenkel model, which takes into account structural equilibrium positions. This model explains adequately the experimental results by considering two molecular motions. In both the glassy state and plastic phase the motional parameters agree with those of 1-cyanoadamantane. On the contrary, in the ordered phase, the motional parameters related to the uniaxial rotation of chloroadamantane molecules indicate an accelerated motion.

Relaxation modes in glass forming meta-toluidine

The dynamics in supercooled meta-toluidine was studied using dielectric relaxation, modulated differential scanning calorimetry, proton spin-lattice relaxation times, and viscosity measurements. The combination of these different techniques has clearly shown a large decoupling of the relaxation modes whose origin is attributed to the formation of clusters via the NH2 bonding. This decoupling starts at a temperature also corresponding to a change of the dynamical behavior from a high temperature Arrhenius evolution to a Vogel-Fulcher-Tamman low temperature evolution.

Solid state NMR and DSC methods for quantifying the amorphous content in solid dosage forms: an application to ball-milling of trehalose

The purpose of this study was to determine quantitatively the amorphous fraction in crystalline-amorphous powder mixtures of trehalose, in order to assess the ability of the (13)C NMR technique for quantitative amorphous characterization. The NMR method is described in detail and its accuracy is compared to that of the DSC technique. Amorphous trehalose was prepared by mechanical milling. Samples with different amorphous fractions were prepared by physical mixing of purely amorphous and purely crystalline powders. The results reveal a close correlation between the imposed compositions of the physical mixtures and those determined by NMR and DSC, indicating that both are useful and accurate methods for compositional characterization of powders. The NMR method is then used to determine the evolution of the amorphous fraction in a trehalose powder, during a milling procedure which ultimately leads to a fully amorphous state.

Orientated growth of crystalline anhydrous maltitol (4-O-α-d-glucopyranosyl-d-glucitol)

In the industrial crystallisation process of maltitol (C(12)H(24)O(11)), the presence of maltotriitol (C(18)H(34)O(16)) in the maltose syrup is responsible for a change of the crystal morphology. Two different crystal forms of maltitol were obtained: a prismatic one and a 'bipyramidal' one. IR and X-ray diffraction experiments (single crystal and powder) were performed to identify both crystal parameters. It is concluded that a structural polymorphism has to be ruled out. Close coincidences in some of the crystal cell parameters of maltitol and maltotriitol allow to assume the process through which maltotriitol affects the morphology of maltitol crystals.